Ebola is spreading again in Congo — this time in an active war zone

Congolese health officials prepare to disinfect people and buildings at the general referral hospital in Mbandaka, Congo, on May 31, 2018.

Congolese health officials prepare to disinfect people and buildings at the general referral hospital in Mbandaka, Congo, on May 31, 2018.

(John Bompengo / AP)

Max BearakWashington Post

Just one week after an outbreak of the Ebola virus was extinguished in northwestern Congo, a new one was declared far away in the country's conflict-hit northeast. This is Congo's 10th Ebola outbreak since the 1970s, and some health officials are worried it might be the hardest to contain.

The new outbreak is centered on a thickly populated stretch of Congo's eastern border with Uganda - an area that is also the epicenter of decades-long clashes between dozens of militias that have forced millions into squalid refugee camps.

While Congo has experienced the most outbreaks of the Ebola virus, this is the first time it has cropped up in this part of the country. Lab tests have confirmed that it is the same strain as the previous outbreak, which started in early May, but there is no indication the outbreaks are related.

There are already 25 suspected cases in the city of Beni, a center for displaced people and home to 350,000 in its own right. There are also two probable cases in Butembo, a city of nearly 1 million and a key trading hub between Congo and Uganda.

"We are still in the early days and there are lots of unanswered questions," said Peter Salama, the World Health Organization's head of emergency response. "But we are expecting this one to be significantly more costly and complex than the last."

At least 43 people are believed to have been infected in North Kivu province, including 36 who have died, Congo's health ministry said on Tuesday; 16 of the cases were confirmed to be Ebola.

As in most past outbreaks - including the vast epidemic that swept Liberia, Sierra Leone and Guinea between 2014-16, killing more than 11,000 - this one likely began to spread quickly when one of the initial cases died and was buried by family members who were unaware that touching the deceased's body would infect them. Salama said the WHO had identified seven family members of a 65-year-old woman who was given an "unsecured burial," all of whom contracted the virus.

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The outbreak that started in May was confined to Equateur province, along the heavily trafficked Congo and Ruki rivers, and ultimately killed 33 people.

The virus was briefly present in the regional trading hub of Mbandaka, raising fears that it could travel rapidly to other population centers or spread within the city, but rigorous tracing of possible cases by Congo's health ministry, WHO, and other public health organizations prevented those worst-case scenarios.

"All the factors that made the Equateur outbreak enormously complex are present in the new one in North Kivu," said Salama. "Urban centers, infected health care workers, proximity to international borders - it's all there. But then you have 20 highly active militias in the region as well, and more than a million displaced by them."

The conflict makes one essential component in preventing Ebola's spread particularly difficult - tracing the contacts of those who are suspected to be infected. There are numerous areas of North Kivu and neighboring Ituri provinces that are highly volatile and often cut off entirely by clashes.

"Beni is more or less surrounded by armed groups," said Nicolas Lambert, the deputy leader of the International Committee of the Red Cross in Congo, who is in Beni. "We have an ongoing dialogue with several of them to negotiate the safety of our health workers. But, more importantly, we must all work to stop the outbreak before it becomes lodged in areas with more active fighting."

According to the Reuters news agency, authorities in North Kivu announced on Tuesday that 14 bodies had been discovered in the town of Tubameme, about 25 miles northeast of the outbreak's epicenter. The various conflicts in North Kivu and Ituri have both ethnic and religious dimensions, and the government, based more than 1,000 miles away in Kinshasa, exerts only sporadic control.

Ironically, the conflict does make the response to the outbreak easier in one way.

The region is home to the world's largest and most expensive peacekeeping operation, known as MONUSCO. They have contributed to the building of roads and airstrips, which will make the delivery of supplies somewhat easier than in Equateur, which has the least developed infrastructure in what is already one of the world's least developed countries.

Experimental vaccines that were successfully deployed in Equateur are in the process of being delivered to the area around Beni. More than 3,000 were leftover in Congo from the last outbreak, and a WHO spokesman told reporters in Geneva on Tuesday that vaccinations of health care workers in North Kivu would start on Wednesday.

The vaccines are made by the pharmaceutical giant Merck, and 300,000 more could be provided on short notice.